Decline in platelet count in patients treated by percutaneous coronary intervention: Definition, incidence, prognostic importance, and predictive factors
Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA. European Heart Journal
(Impact Factor: 15.2).
05/2010; 31(9):1079-87. DOI: 10.1093/eurheartj/ehp594
We investigated the incidence, predictors, and prognostic impact of a decline in platelet count (DPC) in patients treated by percutaneous coronary intervention (PCI).
A total of 10 146 consecutive patients treated by PCI from 2003 to 2006 were included. According to the magnitude of the DPC, the population was divided into four groups: no DPC (<10%), minor DPC (10-24%), moderate DPC (25-49%), and severe DPC (>or=50%). The primary haemorrhagic endpoint was a composite of post-procedure surgical repair major bleeding. The primary ischaemic endpoint was 30-day all-cause mortality-non-fatal myocardial infarction. Among the total population, 36% had a DPC <10%, 47.7% had a DPC of 10-24%, 14% had a DPC of 25-49%, and 2.3% had a DPC >or=50%. On multivariate analysis, moderate and severe DPC were independent predictive factors of the ischaemic outcome. Two procedural practices were identified that, if modified, might reduce the incidence of acquired thrombocytopaenia. Both the intraprocedural use of heparin (as opposed to bivalirudin) and of low molecular weight contrast material were independently associated with severe acquired thrombocytopaenia.
Moderate and severe DPC are independent predictors of adverse bleeding and ischaemic outcomes in PCI. Adoption of intraprocedural anticoagulant other than heparin and avoidance of a low molecular weight contrast agent could potentially decrease the occurrence of severe acquired thrombocytopaenia.
Available from: Michele Schiariti
- "However, the evidence presented here suggests that TC is not directly related to ischemic outcome in post-PCI patients, but is a probable secondary marker for the sickest patients, possibly reflecting the use of either devices, such as IABP, or thrombolytic drugs. This was seen within 861 patients-year (entered the forced Cox model solution with complete data), which is similar to the 833 patients-year figure of study by De Labriolle et al. , where several exclusions were performed , making thus impossible there to ascertain the full role of IABP. There might thus there be a cryptic protagonist to be actively searched and considered in clinical studies aimed at assessing the association between TC and ischemic outcomes. "
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ABSTRACT: Thrombocytopenia (TC) following a percutaneous coronary intervention (PCI) has been associated not only with hemorrhagic, but also with ischemic outcomes. The purpose of this study was to re-examine the relationship of TC with ischemic events at a 1-year follow-up, and investigate the possible associations. Methods and Results We studied a real-world, unselected population of ischemic patients undergoing PCI, totaling 861 patients-year, and divided into two groups: with TC (delta platelet count ≥25% from baseline to post-PCI during the hospital admission) and without TC. Compared with patients without TC, patients with TC had a higher and earlier incidence of both hemorrhagic and ischemic events. In them, the use of intra-aortic balloon pump (IABP) was ten-fold higher. In Kaplan-Meier curves assessing the contribution of both TC and IABP to oucome, IABP was an univariate detrimental factor additive to the role of TC. In a forced Cox model, the relative decline (delta) in platelet count (p=0.05) and the use of IABP (p=0.0001) were both associated with ischemic outcomes. After excluding all patients with IABP, the delta platelet count was no longer significantly associated with ischemic outcomes (p=0.66). After excluding all patients with shock and all those undergone thrombolysis, there was still a relationship (p=0.0042) between the delta platelet count and ischemic events.
In this patient population the use of IABP, but not thrombocytopenia per se, is a possible primary cause of worse ischemic outcomes.
Available from: europepmc.org
- "The CBC demonstrates nonspecific changes in a variety of critical illnesses   . Therefore, nonspecific changes in the CBC in critically ill patients could be considered a key prognostic factor in the evaluation of survival prediction in these patients         . Accordingly, it is possible that the CBC "
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The purpose of this study was to develop a new prognostic scoring system for critically ill patients using the simple complete blood cell count (CBC).
CBC measurements in samples from 306 patients in an intensive care unit were conducted with automated analyzers, including levels of neutrophils, lymphocytes, erythrocytes, hemoglobin, and platelets. The time of sampling and the time of death were recorded. Z values were calculated according to the measured values, reference mean values, and standard deviations. The prognostic score was equivalent to the median of the Z value of each of the measured parameters.
There was a significant correlation between survival time and neutrophil, lymphocyte, and platelet levels (P < 0.05). Prognostic scores were calculated from the Z value of these three parameters. Survival times decreased as the prognostic score increased.
This study suggests that a model that uses levels of neutrophils, lymphocytes, and platelets is potentially useful in the objective evaluation of survival time or disease severity in unselected critically ill patients.
Available from: Erik Lerkevang Grove
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